Inspection on 15/11/06 for Forest Green

This inspection was carried out on 15th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest Green 03/08/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Forest Green 46 Park Road Berry Hill Nr Coleford Glos GL16 7AG Lead Inspector Mr Richard Leech Unannounced Inspection 13:00 & 15 & 16 November 2006 10:30 th th Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Green Address 46 Park Road Berry Hill Nr Coleford Glos GL16 7AG 01594 836866 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.brandontrust.org The Brandon Trust Mr Charles Patrick Bunn Care Home 5 Category(ies) of Learning disability (5), Physical disability (1), registration, with number Sensory impairment (1) of places Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 Brief Description of the Service: Forest Green is a detached house providing care and accommodation for up to five adults with learning disabilities, some of whom may also have physical disabilities and sensory impairments. The home is situated near Coleford in Gloucestershire. The property has a basement, ground floor and first floor. There is a large garden. All service users are accommodated in single bedrooms on either the ground or first floor. At the time of the inspection there were four people living in the home. The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Up to date information about fee levels was not obtained during this visit. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Wednesday afternoon for about three hours. A second visit was made on the following day from mid-morning through to early evening. All of the service users were met, along with many of the staff team. The manager was present on both days. Before the visit a pre-inspection questionnaire was returned. Feedback was also obtained through staff, care manager and service user surveys. During the visits to the home various documents were checked including examples of care plans, risk assessments, medication charts, daily records and staffing files. Some staff and service users were spoken with and time was also spent with the manager. Some general observation of life in the home took place and the premises were inspected. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service Users Guide have been reviewed and updated, with some further work due to take place to make them more accessible. There have been some improvements to medication records in the home. Developments have taken place around quality assurance, with frameworks in place for checking and improving the quality of the service. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of an up to date admissions policy may compromise a fundamentally sound approach to referrals and admissions. EVIDENCE: In the last report a requirement was made about reviewing and updating the Statement of Purpose and Service Users Guide. This has been done, although final proof reading was taking place. The manager said that photographs would be added to make the document more accessible. At the time of the visit the home had a vacancy. The manager described referrals to date and the steps taken to assess their needs and obtain background information. The manager uses an assessment tool based on the ‘Ordinary Living’ model, also used to assess the needs of people already living in the home. The manager confirmed that visits to the home are offered as part of the admissions process, and described how compatibility with other service users would be considered. The manager had not devised a vacancy profile or local admissions procedure, as expected by the Brandon Trust’s overall admissions policy. However, this procedure itself dates from 2000 (before the National Minimum Standards) and should therefore be reviewed in order to fully take into account the Standards. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Reasonable arrangements are in place around care planning, although there is significant potential for further development to promote best practice. The service has a commitment to offering people choice and control, although aspects of documentation and practice could be improved. Systems are in place to assess and manage risks, providing a framework for promoting service users’ safety. EVIDENCE: Two care planning files were checked in detail as part of case tracking two of the people living in the home. In general the plans provided clear, succinct guidance about people’s support needs and covered appropriate areas. The following points are made: Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 10 • • • • • • • • • Front sheets and basic information records may need update in some cases. For example, one document noted the home manager as the person’s next of kin. Although most care plans were seen to have been reviewed within the last six months, some were out of date, such as activity timetables in one case. The manager said that he was considering introducing monthly reviews of care plans. Wider ranging ‘care team reviews’ were documented (which take place in addition to reviews of each plan). In some cases these meetings had not taken place since November 2005. It was agreed that they were therefore due. The manager said that this would happen as part of introducing person centred care planning. Care plans had aims. However, it was suggested that during reviews of care plans there should be greater consideration of the extent to which the aim was being achieved and any barriers to fulfilling the aims. This should also be documented. Related to the above, the majority of care plans seen had been written in 2004 and very few changes had been made as a result of reviews. It was suggested that this was surprising and that the review process could be assessed. Assessments were in place for each service user. Reviews were seen to have taken place in November 2005. It was agreed that another review was therefore due. However, the manager said that this would be integrated into the plans for a move towards using person centred planning formats. One person’s plan on managing anxiety stated that staff were to apply de-escalation techniques, without indicating what these were/what worked well with the individual. It was accompanied by relatively dated guidance which gave advice such as, ‘do not make threats that cannot be carried out’. It was agreed that this should be replaced with more up to date guidance on the principles of de-escalation. The manager said that one person whose care was tracked had a diagnosis of an autistic spectrum condition. However, this was not apparent from their assessment or care plans. It was suggested that this be made more explicit, including clear reference to the individual impacts and manifestations. More generally, care-planning files included contracts and some procedures from the former service provider. The team had recently had training about person centred planning. The manager said that work would now begin on introducing person centred planning formats (probably ‘Essential Lifestyle Plans’), working with each service user to generate new plans more reflective of their perspectives. Care plans included references to respecting people’s choices. Staff gave examples of how they did this in practice, such as about personal care routines and food/drink. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 11 Care plans and risk assessments also made reference to some limitations and restrictions. However, it was agreed with the manager that in some cases this needed clearer documentation and justification, as far as possible in consultation with the person affected. These also need to be subject to review. Examples included: • • One person not having access to some of their clothing. Staff were able to give an account of the reason for this, but documentation did not fully reflect the issues which had resulted in this restriction being imposed. The same person had a basin in their room which was not connected to the water supply. This restriction was not seen to be documented anywhere on their file. Practice should always be the least restrictive possible, although it is accepted that at times it will be necessary to impose restrictions and limitations (see Standard 7 of National Minimum Standards). Standard 7.5 indicates that where support around management of finances is needed the reasons for, and manner of, support are documented and reviewed. There was some guidance around spending, but these did not describe why there was a need for support in this area and what that would consist of. Risk assessments were checked in two files. These provided clear guidance about how risk issues were managed. There was evidence of regular review. The Trust has a missing person’s procedure dating from 2006. Photographs and identifying details are on file and could be passed on quickly in the event of an emergency. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a strong commitment to supporting people to access activities appropriate to their needs and interests, promoting their quality of life. Service users are supported to maintain and develop contact with important people in their lives. People’s individuality is respected and there is an awareness of issues around rights and freedoms. Service users’ health is promoted by the provision of a balanced diet, although closer attention may need to be paid to individual needs in order to ensure that practice is consistent. EVIDENCE: Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 13 Activity records were checked from daily notes. In one case these provided evidence that the person accessed a range of activities including leisure and more vocational activities. This included trips out at the weekend. The person indicated that they enjoyed how they spent their time. Another service user had fewer activities recorded. There have been long-standing difficulties identifying appropriate activities for the person. Staff described what had been tried and what ideas there were for the future. It is recognised that the team has made, and continues to make, great efforts to establish what activities the person enjoys and to try to create a fulfilling programme. Another service user expressed satisfaction with how they spent their time and indicated that they had plenty to do. They described a recent holiday abroad, expressing how much they had enjoyed this. A service user’s comment card was positive about the activities that were accessed. Community activities included meals out, trips to shops and markets and using local facilities such as a hairdresser. The manager reported that the activities budget was under pressure. The impacts of this will be monitored during future inspections. Some staff felt that there should be a second vehicle as only having one was limiting service users’ opportunities. Daily records, care planning files and discussion with staff provided evidence that service users are supported to develop and maintain contact with family and friends as far as possible. People living in the home were seen to move around the building freely. Where there were barriers to access these were accounted for in care planning files. Staff described people’s daily routines and how they promoted flexibility and respected individuality, although in some cases service users preferred to keep to a routine. There were notes on people’s files about voting in elections dated May 2005. It is assumed that these would be reviewed when another national or local voting opportunity arose. There was a discussion with the manager about people’s preferred form of address. It was noted that some staff were calling service users ‘love’. The manager felt that this was appropriate terminology reflecting a friendly and warm relationship between staff and service users. The manager felt that the term ‘good girl’ was also appropriate in one case since it was a phrase that had been used for a long time and with which the person was familiar. Nonetheless this and other terms of address should be considered by the team. People’s preferred form(s) of address should be recorded on their files. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 14 Menus and food records provided evidence that a balanced diet was offered to service users. Examples were given of when people had been offered an alternative to what was on the menu to reflect their own preferences. Two meals were observed. The food was appetising and the atmosphere relaxed. Some service users indicated that they liked the food and confirmed that their favourite dishes were served regularly. One person has particular dietary needs. This includes a recommendation to avoid certain foods, as listed in their care-planning file and on a list in the kitchen. During the inspection a staff member was about to offer some grapes to the person but another team member intervened, this being noted as a food to avoid. This suggests that practice may be inconsistent and that staff may need to refamiliarise themselves with the list. Some weight charts were seen on files. In one case the most recent dates were for March and May 2006. People’s weights should be taken/recorded more often if possible. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal healthcare needs are met, enhancing their dignity and wellbeing. Healthcare needs are also addressed, though there is scope for improving aspects of practice in this area to further safeguard people’s health. Good systems are in place around the handling of medication, although there is potential to improve some areas of policy and recording in order to promote best practice. EVIDENCE: Care plans provided guidance about how people’s personal care needs were to be met. These included information about people’s routines and preferences and there were notes about respecting service users’ choices. Staff were seen offering personal care support in a sensitive manner. Staff spoken with described how they met personal care needs in ways which respected people’s preferences, privacy and dignity. People living in the home were seen to be dressed smartly and individually. One person had just had their hair cut, using a local service in the community, and was clearly very proud of the result. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 16 Healthcare notes provided evidence that service users were being supported to access routine and specialist healthcare according to their needs. However, the following observations were made: • Some recording in healthcare notes was patchy. For example one person was recorded as missing a dental appointment in May 2005, with a new appointment having been made. However, there was no subsequent entry in the dedicated section for dental treatment. Also some important medical information about a nurse coming to take bloods for one person had been recorded in daily notes but not in the relevant healthcare section of the file. There was a discussion with the manager about flu jabs. The manager said that some people had chosen not to have these. However, no record could be found of this or of any discussion around the risks of not having one being explained to the person. There should be clear documentation around health issues such as this, with best interests work taking place if necessary. • There was evidence on file of engagement with the Community Learning Disability Team in some cases, and of recording taking place as requested by the CLDT for monitoring purposes. A recommendation had been made in the last report about taking forward health action planning. The manager said that this had not been done but that he intended to introduce it in conjunction with person centred planning. Medication records and storage appeared to be in order. The manager and staff described training that staff had undertaken to promote competence in this area and some certificates were seen as confirmation of this. The allergy section on the MAR charts was completed in some cases, though this was inconsistent. A staff member said that this had been raised with the pharmacy and that this would be pointed out again. Some handwritten entries on MAR charts did not have two signatures (author and second signature to confirm that the entry has been checked as correct). Some medication profiles appeared not to have been reviewed and updated since 2003. These should be reviewed regularly to ensure that they remain accurate. The Trust’s medication policy dated from 2000 and was marked as pending review. It included reference to the Registered Homes Act. This review should be done as soon as possible since a variety of new guidance has been generated since then. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for managing complaints, although aspects of policy need review in order that people have the information that they need. Systems are in place which help to protect service users from harm and abuse. EVIDENCE: The Trust’s complaints procedure dates from 2003 and consists of a text and symbol version. It is understood that the latter is going to be reviewed to make it more accessible. The procedures require review in any case since there are no contact details for CSCI included (although the manager has included this information in the Service Users Guide). Service users spoken with indicated that staff were good listeners and that they could talk to them if they were unhappy about something. This was backed up by information in a service user’s comment card. Staff in turn described how they could tell if people were unhappy and how they responded. Regarding adult protection, there were copies of the local procedures and of the guide to PoVA in the home. The Trust has a thorough adult protection procedure dated 2005. There is a whistle blowing policy dating from 2000. Several staff had recently attended training about the protection of vulnerable adults, with other team members due to attend in the near future. Staff Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 18 spoken with had a good understanding of adult protection issues and their responsibilities in this area. Staff said that there was no restrictive physical intervention used in the home, describing de-escalation techniques that they used. Discussion with service users and a survey card provided evidence that people living in the home felt safe there. Records of service users’ finances were sampled and those seen appeared to be in order. There were many ‘petty cash vouchers’ where staff had not obtained a receipt for a transaction. Whilst it is accepted that on some occasions it will not be practical to get a receipt, this should be done wherever possible. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is significant scope to improve the environment, making it a more homely, clean and comfortable place to live. EVIDENCE: At the time of the inspection the home had a vacancy. The intention was for a person to move into the room currently used as an office/sleep-in room. It was agreed that careful consideration would need to be given to where the office and sleep-in area were moved to in terms of issues such as accessibility, and also to protecting service users’ freedom to access existing communal areas at any time of their choosing. There is an outstanding requirement about redecorating an area of the first floor lounge that had been affected by damp, where there is peeling and flaking paint. The cause of the damp appears to have been resolved. However, the affected area had not been redecorated. The manager hopes to have the Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 20 whole room redecorated. It was agreed that this would be preferable, including replacing the curtains which are faded and tatty. There was also a requirement about arranging all necessary further work to treat areas affected by damp in the basement (including investigating whether parts of the laundry/adjoining cupboard were damp). A letter from the Housing Association indicated that this work would take place in January 2007. The manager understands that this will include refitting the laundry. Two bedrooms were seen. They were pleasant and personalised. Service users spoken with expressed satisfaction with their rooms. Communal areas were generally homely and comfortable. The manager said that the sofas in the ground floor lounge were going to be replaced. In the last report a recommendation was made to consider whether some areas of the home would benefit from being ‘freshened up’. The manager felt that the hallway should be redecorated. It was also agreed that the first floor landing, sensory room and ground floor toilet would be improved by redecoration. Some staff felt that the area behind the toilet on the ground floor should be tiled. In addition, the handrails outside the front door should be repainted as the paint is peeling/flaking. There have been suggestions in previous reports to improve ventilation in the laundry, such as by fitting an extractor fan, and to fit window restrictors in the first floor. These have not been implemented. The manager felt that ventilation in the laundry was generally adequate, though said that a fan had been included in the design for a refit of the laundry. The carpet in the sensory room was badly stained. The flooring in this area must be cleaned or replaced. The manager said that he hopes to make the first floor bathroom more pleasant and homely. It was agreed that this could include fitting a mirror. At the time of the inspection the microwave oven was not working. There had apparently been some confusion about whether the Trust or Housing Association were responsible for repairing/replacing this, though this was being resolved. The home appeared to be clean and hygienic throughout, though as noted there are some areas which require attention by external contractors in order to make the environment more clean and hygienic. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support is provided by a skilled and committed staff team, helping to ensure that service users’ needs are appropriately met. Improvements need to be made to aspects of recruitment and selection procedures in order to safeguard service users as much as possible. Greater provision of specialist training would help to promote best practice in the service. EVIDENCE: Discussion with the manager and staff indicated that 50 of the staff team (excluding the manager) are qualified to at least NVQ level 2. Staff spoken with had a good knowledge of service users’ specialist needs and conditions, and of how each person communicated. Interactions with service users were observed to be skilled, caring and professional. Service users appeared relaxed with the staff. One person’s survey card included the Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 22 comments, ‘nice staff’ and ‘I like living at Forest Green’, although they also noted that at times the home could be quite noisy. The manager described recruitment and selection procedures in the service. He expected to undertake training about recruitment and selection in the near future to reinforce knowledge of best practice in this area. It was agreed that a copy of a recent CSCI report on recruitment and selection would be forwarded for information. Only one new staff member had recently joined the team. The staffing file was checked and contained all expected documents besides not having a second reference. It was agreed that this was a concerning shortfall which indicated a weakness in the system either for sending for references or for forwarding them to the home. However, it was also agreed that the manager shares accountability in this area and should have checked the documentation forwarded by Human Resources. A written induction format was seen for the person. This required review since there was reference to the old service provider, although it is expected that the Trust will be rolling out its own induction format to complement any in-house tools. The format was also signed to say that all areas had been completed rather than there being signatures and dates alongside each individual subject covered (thereby providing a clearer record of the induction process). A recommendation is not made in this area on the expectation that changes to induction procedures and formats will be made in the near future across all local services run by the Trust. Records along with discussion with the manager and staff indicated that ‘mandatory’ training was generally either booked or had taken place. Staff said that there had been some difficulties accessing certain training such as food hygiene. Basic staff training will be monitored in future inspections. As noted there had been recent training about person-centred practice and the protection of vulnerable adults. The manager said that some staff had asked to attend training about autism and that he was looking into this. In the last report a recommendation was made about conducting a training needs audit to identify specialist training which would be appropriate for all or some of the team. This recommendation is repeated. During this visit some staff indicated that they would like additional training in areas such as makaton and on sexuality and learning disability. Training about the forthcoming Mental Capacity Act should also be accessed as this will have significant implications for all services. The manager described some issues around dynamics in the team, along with various ideas for addressing this including team building activities. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 23 A staff member’s CRB certificate was handed by the manager to a different staff member by accident, attached to a training certificate which had been requested. Whilst it is fully accepted that this was accidental, it represented a breach of confidentiality/data protection and indicates that sensitive personal information should be stored apart from documents which may be more routinely accessed like training records. The guidance about retaining/destroying CRB certificates was discussed and the manager was referred to the CRB and CSCI websites for up to date information about this. A record of a staff meeting from 12/11/06 was viewed. This was wide ranging and covered areas such as person centred planning, advocacy and health & safety. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run, though a more proactive and dynamic approach may help to further improve outcomes for service users. Systems are in place which help to monitor and improve the quality of the service provided, though improvements could be made. Some significant health and safety shortfalls could place service users at unnecessary risk. EVIDENCE: The manager confirmed that he maintains his nursing qualification and that he obtained the Registered Manager’s Award in 2005. He had begun a programme of professional development courses related to his role, including areas such as the process of management, budgeting, performance management, leadership Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 25 and coaching. The Statement of Purpose notes that he had also undertaken additional management courses and was an NVQ assessor. Although various responsibilities are delegated among the team, the manager said that the absence of a senior social care worker (on a secondment at the time) was impacting on management functions. A process of recruitment (for secondment) was underway at the time of the inspection. Much positive feedback was obtained through staff surveys, including for areas such as induction, supervision and support. Staff spoken with added that the manager was approachable and that the home was well run. Some people felt that there should be better support and communication from the Trust. However, comments were also made about the manager not always being sufficiently aware of staffing issues/dynamics and that prompt action was therefore not always taken to address these issues before they developed, impacting on morale and cohesion. There was discussion about this and the manager felt that he could make changes to areas such as the structure of supervision meetings. As indicated throughout the report, although the service has many strengths there are also a number of areas where improvements could be made in line with best practice, such as through the introduction of person-centred planning and health action planning and by provision of more specific training. There has been some delay in implementing these initiatives. In the last report a requirement was made to establish and maintain a system for reviewing and improving the quality of care provided. The Trust has devised some quality standards and home managers were asked to complete a self-audit which would in turn be checked by their line manager. The manager said that this had been completed by him. It is understood that the quality standards are to be reviewed following this initial exercise. The manager said that he was considering devising tools for gathering feedback from service users and people involved in their care, though nothing new was yet in place. The Statement of Purpose describes how service users are consulted about the running of the care home, including through regular client meetings. Minutes from one of these meetings were seen, where discussion included the food served in the home. The manager said that there had been two so far that year. These should be more frequent if the service users find this a useful way of giving their views. Regulation 26 reports are being forwarded following monthly visits by representatives in the Trust. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 26 As noted earlier, care team reviews should be more frequent – in some cases there appeared not to have been a recorded meeting for a year. Health and safety was considered. The Trust’s health and safety policies and manual were seen. During the inspection some health and safety lapses were noted, suggesting that greater care and vigilance may be needed. These included: • • • A sharp knife being left unattended on a table next to a service user who had profound and multiple disabilities including a sensory impairment. The cupboard in which hazardous chemicals are stored being left unattended and unlocked. Some strong cleaning fluid being splashed onto a roll of toilet paper in a toilet to the extent that it may have posed a chemical hazard. Fridge and freezer temperatures were seen to be recorded daily (though not always twice daily as per the system in the place in the home). It was suggested that the acceptable parameters could be added to the template for reference. The first aid box contained some out of date items. However, this had already been noticed by some staff and arrangements were being made to replace old stock. Policies and procedures about fire safety were seen, including guidance about recent changes to legislation in this area. The manager said there was a meeting planned for the following week in which the process of reviewing and updating the fire risk assessment would begin. The fire logbook was checked and the following noted: • • • There were only five records of emergency lighting tests for 2006 (plus routine servicing). Testing of the fire alarms was patchy, with a gap from 04/09/06 to 02/10/06 when no weekly tests had been recorded. The most recent fire drills were recorded as 13/10/05 and 24/10/06. However, the manager said that the most recent one had been unplanned (the fire alarms had sounded as some food had burnt). Planned fire drills are therefore not taking place at an appropriate frequency. It is understood that the fire authority is now the lead agency in enforcing fire safety issues. However, the manager needs to address these shortfalls urgently, and should consider wider fire safety issues as part of the review of the fire risk assessment. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 27 Records/evidence for other routine checks were seen including vehicle safety checks, hot water temperatures (thought this was due, the last having been 25/09/06) and portable appliance testing. The manager said that the boiler/central heating had been serviced in September 2006. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 1 x Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 14 & 15. 17 (1) a. Sch. 3 (3) q. 22 (7) 23 (2) d Requirement Where limitations and restrictions are agreed with a service user there must be a clear record of these (including a rationale) and they must be subject to review. The complaints procedure must include the name, address and telephone number of CSCI. Redecorate the area in the first floor lounge which had been affected by damp. Timescale of 31/08/06 not met. Assess whether any areas of the basement (including the laundry) continue to be affected by damp. If so then arrange for any necessary work. Redecorate affected areas. Timescale of 30/09/06 not met. Clean or replace the flooring in the sensory room. There must be a minimum of two written references available in the home for all members of staff. Ensure so far as reasonably practicable that all parts of the home to which service users have access are free from DS0000066989.V320034.R01.S.doc Timescale for action 31/01/07 2 3 YA22 YA24 28/02/07 31/01/07 4 YA24 23 (2) b & d 31/01/07 5 6 YA24 YA34 23 (2) d 19. Sch. 4 13 (4) 28/02/07 31/12/06 7 YA42 30/11/06 Forest Green Version 5.2 Page 30 hazards to their safety. Ensure that unnecessary risks to service users’ health and safety are identified and so far as possible eliminated. (This relates to the health and safety shortfalls identified in the text of the report) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA6 Good Practice Recommendations The Trust should fully review and update the admissions policy dating from 2000. Take forward work on introducing a more person centred form of care planning in the home. Address the bullet points made in the text about care planning files. Where support around management of finances is needed the reasons for, and manner of, support should be documented and reviewed. Consider whether a second vehicle should be available, particularly if and when a fifth person moves into the home. Terms of address and endearment in use in the home should be considered/reviewed by the team. People’s preferred form(s) of address should be recorded on their files. Staff should ensure that they are familiar with the list of foods to avoid giving one service user. Aim to take and record service users’ weights more frequently. Introduce ‘health action planning’, involving healthcare professionals as appropriate. Address the points made in the two bulleted sections of the text. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 31 3 4 5 YA7 YA12 YA16 6 YA17 7 YA19 8 YA20 Handwritten entries on MAR charts should have two signatures (the author plus the signature of a second designated person who has checked that the entry is correct). Review and update medication profiles. The Trust’s medication policy dated 2000 should be reviewed as soon as possible to take into account the National Minimum Standards as well as other relevant guidance since then. Obtain receipts wherever possible for transactions involving service users’ money, using petty cash vouchers only in exceptional circumstances where it is not possible to obtain a receipt. Consider redecorating the first floor landing, the sensory room and any other areas of the home which would benefit from ‘freshening up’. Consult with service users about this. Consider also redecorating the whole of the first floor lounge rather than just the area affected by damp, including replacing the curtains. Consider whether tiles should be fitted behind the toilet on the ground floor. Improve ventilation in the laundry, such as by fitting an extractor fan. Consider fitting window restrictors throughout the first floor. The handrails outside the front door should be repainted. Based on a training needs audit, identify specialist training which would be of relevance to staff in the roles they perform (such as about learning disability and mental health, autistic spectrum conditions, makaton, learning disability and sexuality, and the needs of older people with a learning disability, as cited by staff during this and previous visits). Provide opportunities for staff to attend this training and to cascade the learning to the rest of the team. 8 YA23 9 YA24 10 11 12 13 YA24 YA24 YA24 YA35 14 15 YA39 YA42 Access training about the Mental Capacity Act. Depending on service users’ views about the client meetings, consider making these more regular. Add the acceptable parameters for fridge and freezer temperatures to the template, for reference. Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Forest Green DS0000066989.V320034.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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